ISSN (Online) : 2319 – 8753
ISSN (Print) : 2347 - 6710
International Journal of Innovative Research in Science, E ngineering and Technology
An ISO 3297: 2007 Certified Organization,
Volume 3, Special Issue 1, February 2014
International Conference on Engineering Technology and Science-(ICETS’14)
On 10th & 11th February Organized by
Department of CIVIL, CSE, ECE, EEE, MECHNICAL Engg. and S&H of Muthayammal College of Engineering, Rasipuram, Tamilnadu, India
Functional Electrical Stimulation for Grasping In
Hemiplegic Patients
S. Maheswari1, A. Anusuya2, P. Preveena3, R. Sangeetha4
Assistant Professor, Department of Biomedical Engineering, Sri Ramakrishna Engineering College, Coimbatore, India1
Student, Department of Biomedical Engineering, Sri Ramakrishna Engineering College, Coimbatore, India2, 3, 4
ABSTRACT: Functional electrical stimulation (FES) is
an effective technique for the hand rehabilitation
functions such as grasping and releasing. The
paralysed patients cannot carry out the activities of
daily living. This system can be used for the stroke and
spinal cord injured individuals. The technology used
in the restoration of hand functions are generally used
for the neuro prosthetic restoration. Several
prospective studies have shown that repeated motor
practice and the motor activity in the real world
environment have a favourable effect on the motor
recovery in stroke patients. Functional Electrical
Stimulation induces greater muscle contraction by
providing stimulus through the electrode. By applying
stimulus through the electrode, the grasping and the
releasing actions has been achieved. The level of
stimulation for the paralysed hand can be adjusted by
using the control knob. This stimulation adjustment
makes the patient to feel comfort.
techniques. Rehabilitation is the main treatment of the
individuals with hemiplegia. In all cases, the major aim of
rehabilitation is to regain maximum function and quality
of life. The exact cause of hemiplegia is not known in all
cases, but it appears that the brain is deprived of oxygen
and this result in the death of neurons. When the
corticospinal tract is damaged, the injury is usually
manifested in the opposite side of the body. For example
if one has an injury on the right side of the brain, the
hemiplegia will be on the left side of the body[6]. This
happens because the motor fibres of corticospinal tract,
which take origin from the motor cortex in brain, cross to
the opposite side in the lower part of medulla oblongata
and then descend down in spinal cord to supply their
respective muscles[7]. Depending on the site of lesion in
brain, the severity of the hemiplegia varies. A lesion in
internal capsule where all the motor fibres are condensed
in a small area, will cause dense hemiplegia i.e. complete
loss of power of all muscles of one half of the body.
Keywords: Functional Electrical Stimulation, Neuro
prostheses, Stroke, Hand paralysis.
II. MATERIALS AND METHODS
I. INTRODUCTION
Functional electrical stimulation has been
applied to provide control for the movements or the
functions by generating electrical stimuli to the nerves or
muscles. It is also helpful to restore the lost functions of
the hemiplegic patients. The daily activities of the patients
are also impaired. The most common cause of hemiplegia
is stroke. Strokes can cause a variety of movement
disorders, depending on the location and the severity of
the lesion. Hemiplegia is common when the stroke affects
the corticospinal tract. Other causes of hemiplegia include
spinal cord injury, specifically Brown-Sequard syndrome,
traumatic brain injury, or diseases affecting brain[8]. As a
lesion that results in hemiplegia occurs in the brain or
spinal cord, hemiplegic muscles display features of the
Upper Motor Neuron Syndrome. Physical therapy can
improve muscle strength and coordination, mobility and
other physical functions using the different sensorimotor
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Our main aim was to implement the grasp and
release patterns and also to find a practical way for their
reproducible generation. One major request was to use
surface electrodes placed only on the forearm eliminating
the need for electrodes on or inside the hand. First, the
lateral grasp pattern providing the ability of picking up
flat objects between the flexed fingers and the flexing
thumbs has been achieved by stimulation of finger(M.ext.
digitorum communis) and thumb (M.ext. pollics longus)
extensor muscle for hand opening, the fingerflexors
(M.flex.digitorum
superficialis,
M.flex.digitorum
profundus) for hand closing and the thumb flexor(M.flex.
pollicis longus) for grasping[5].
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862
ISSN (Online) : 2319 – 8753
ISSN (Print) : 2347 - 6710
International Journal of Innovative Research in Science, E ngineering and Technology
An ISO 3297: 2007 Certified Organization,
Volume 3, Special Issue 1, February 2014
International Conference on Engineering Technology and Science-(ICETS’14)
On 10th & 11th February Organized by
Department of CIVIL, CSE, ECE, EEE, MECHNICAL Engg. and S&H of Muthayammal College of Engineering, Rasipuram, Tamilnadu, India
B. Neuroprosthesis for Grasping
The neuroprosthesis applies FES to artificially
generate muscle contractions to perform reaching &
grasping tasks in subjects who lost voluntary control of
these muscles due to disease or injury[2]. It uses bursts of
short electric pulses of pulse width 0-250 microseconds
and pulse amplitude 10-150mA to generate muscle
contraction by stimulating motor neurons or reflex
pathways.
Fig1: Muscle motor points identification
By using a dedicated stimulation profile it has
been possible to use a contraction of the thumb flexor and
the extensor muscles to achieve a state, in which the
fingers are sufficiently flexed and the thumb is still in an
extended position. This stimulation profile has been
iteratively determined during an initial screen session as
shown in fig1. Second, for the palmar grasp a branch of
the median nerve innervating the M.opponents has been
selectively stimulated with an electrode placed on the
forearm[4]. After the electrode positions have been
defined during the initial setup session. The Velcro strips
hold the electrodes in s fixed position. Due to the
voluntary wrist extension and a denervation of the wrist
extensor muscle in our end user, it was not possible to
achieve a stable dorsal extension of the wrist by
stimulation.
III. EXISTING SYSTEMS
A. FES therapy for spasticity in stroke patients with upper
extremities
The functional rehabilitation uses an EMGcontrolled stimulator with a pair of surface electrodes
records both EMG & delivers electrical stimulation[1].
The main drawback of EMG-triggered neuromuscular
electrical stimulation system cannot control electrical
stimulation in proportion to voluntary EMG after onset of
preprogrammed electrical stimulation.
Currently, FES systems are used to improve the
functionality for disability patients. The feasibility of
using accelerometer controlled electrical stimulation for
the elbow, wrist and finger extensors which enables
functional task practice in patients with chronic
hemiparesis but the accelerometer is controlling electrical
stimulation in which the trigger for stimulation is directly
associated with forward reach and grasp as shown in fig2.
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Fig2: Handmaster neuroprothesis
1) Use of an implanted FES system: These devices should
only be applied once the patient reached stable
neurological status & no further improvements of
function are expected. It usually applied to SCI subjects
two or more years after trauma.
2) Use of surface FES system: This system introduces
FES training during early rehabilitation period because
the technology does not require from subject to be
neurologically stable.
C. Artificial grasping for the paralyzed hand
Here 8 channel microcomputer controlled
stimulator with monophasic square voltage output was
used and muscle activation sequences were power
grip(index finger extension type). The electrical
stimulation has the potential for exciting every muscle
with intact peripheral enervation[3].
The main drawback is maximum pulse width
was fixed at 300 microseconds & frequency at 20 hertz
then amplitude was adjusted to achieve excitability
threshold for each muscle. The possibility to obtain a
functional grasp despite an open loop fixed stimulation
parameter system and surface electrodes. Fine movements
of hand could be performed by voluntary movements of
shoulder & elbow allowing objects to write & training can
improve pen control and writing speed.
IV. PROPOSED SYSTEM
For continuous contraction of hand muscles, a
FES system has to deliver 16 stimulation pulses per
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ISSN (Online) : 2319 – 8753
ISSN (Print) : 2347 - 6710
International Journal of Innovative Research in Science, E ngineering and Technology
An ISO 3297: 2007 Certified Organization,
Volume 3, Special Issue 1, February 2014
International Conference on Engineering Technology and Science-(ICETS’14)
On 10th & 11th February Organized by
Department of CIVIL, CSE, ECE, EEE, MECHNICAL Engg. and S&H of Muthayammal College of Engineering, Rasipuram, Tamilnadu, India
second & this will elicit action potentials in the motor
nerve. Controller is programmed to generate square pulse
width 250microseconds and frequency. Of 40hertz and
amplitude is individually adjusted to achieve threshold for
flexion & extension.
Stimulation pulses are applied through the skin
to the nerves via electrodes. The main advantage of using
silicon rubber electrode are high thermal conduction and
electrical stimulation and also reduce chronic & acute
pain from various causes.
Stimulation pulses are applied through the skin to the
nerves via electrodes.
 For flexion-Range of 0 to 180V
 For extension-Range 0 to 180V
The voltage input to L-Driver is varied with variable
supply circuit.
Fig 3a: Flexion of the hand
V. RESULTS AND DISCUSSION
The study was now carried out with two patients
who had different residual capabilities. The first patient is
a 70 years old man who has suffered hemorrhagic stroke 6
months before and he did not have any sense in the paretic
arm. The second patient is 57 years old man who had
stroke 2 years earlier but in this case he is now using his
forearm for limited activities but the residual capacity is
not completely recovered. The user can start the two
channels individually or simultaneously. The maximum
voluntary contraction levels of forearm showed good
variations.tha arm spasticity and muscle tone were also
seemed to improve on the basis of regular usage. From
the present results we could suggest that intensive FES
therapy would improve the forearm functions which is
attributed to the enhancement of coordinated muscle
activity and improved muscle tone. The figure 3a, 3b and
3c shows the flexion and the relaxation of the hand and
also the finger movements performed by using this
functional electrical stimulation. By using this therapy
continuously, the patient can able to perform the functions
without using this stimulation.
Fig 3b: Relaxation of the hand
TABLE I : BASIC DATA OF PATIENTS PARTICIPATED
PATIENTS
AGE
GENDER
DIAGNOSIS
PROVIDED
VOLTAGE
Patient 1
65
Male
Partially paralysed
80V
Patient 2
72
Male
Fully paralysed
180V
Patient 3
59
Female
Cerebral vascular
accident
130V
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Fig 3c: Finger movements performed by using FES therapy
Subjects and family members learnt how to use
the device. The electrode placement and stimulation
levels are individualized for each patient. The FES system
would need such a long time as six months to recover the
complete functioning of forearm. When compared to
other systems this is portable and easy to use and can be
performed at home every day. Also the time consuming
factor is reduced comparing the devices which use EMG
www.ijirset.com
864
ISSN (Online) : 2319 – 8753
ISSN (Print) : 2347 - 6710
International Journal of Innovative Research in Science, E ngineering and Technology
An ISO 3297: 2007 Certified Organization,
Volume 3, Special Issue 1, February 2014
International Conference on Engineering Technology and Science-(ICETS’14)
On 10th & 11th February Organized by
Department of CIVIL, CSE, ECE, EEE, MECHNICAL Engg. and S&H of Muthayammal College of Engineering, Rasipuram, Tamilnadu, India
sensing modules. Daily usage at home can change the
physical status and functional abilities for the patients
who were receiving long term treatments. At last
reporting that continuous usage would be needed to
achieve fine grip movements in hemiplegic patients.
2.
3.
4.
VI. CONCLUSION
In this study, the patient with hemiplegia used
their residual capabilities to restore the hand functions by
adjusting the control knob for providing the appropriate
stimulus. The subjects can successfully operate the FES
system by surface electrical stimulation. We can further
improve the system by designing forearm orthotics or
positioning sensors.
5.
6.
7.
REFERENCES
1.
Francisco Molina Rueda. María Carratalá Tejada. Alicia
Cuesta Gómez. Javier IglesiasGiménez. Francisco Miguel
Rivas Montero-‘FES therapy for spaspicity in stroke patients
with upper extremities’.
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Milos R. Popovic1,2, Dejan B. Popovic3 and Thierry
Keller4,5’Neuromuscular Electrical Stimulation’.
Maria Claudia Ferrari de castro and Alberto Cliquet,Jr’Artificial Grasping System For
The Paralyzed
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Yukihiro Hara ‘Rehabilitation with Functional Electrical
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Thrasher,PhD,Vera
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Ying-hanCchiou, Jer-junn luh, Shih-Ching chen3, ‘Residual
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Barbara M.Doucet,’High vs. Low Electrical Stimulation
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